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Billing for Spot Images (Or Not)

billing

By Melody Mulaik

In some practices there are situations that arise where the radiologists are asked to interpret images, aka “spot” images, in conjunction with other procedures, typically performed by other specialties. Before getting to the coding of these procedures it is first important to ask why the radiologists are reviewing the images. Is there really an order for them to interpret the study or are they reviewing the images simply because they are in their PACS work queue? Other issues such as contracting and hospital policies may also come into play. If there is not an order and/or their interpretation is just filed and not really used by the other physician to provide care to the patient, then the service should likely not be billed. Following are some common scenarios that many practices encounter for spot images.

When spot images are taken during a procedure performed by a radiologist, the radiology group should bill only for the procedure’s surgical component and radiological supervision and interpretation (S&I) codes. The radiological S&I includes interpretation of any spot images obtained during the procedure. It would not be appropriate for the radiology group to submit both the S&I code and additional codes for interpretation of spot images.

In situations where a radiologist is asked to interpret spot images taken during procedures performed by non-radiologists it is not appropriate to assign fluoroscopy code 76000 since the radiologist was not present to supervise the imaging. (CPT® Assistant, September 2014) It doesn’t happen often but, in some cases, there is a CPT® S&I code for the procedure being performed by the non-radiologist. For example, code 74330 represents the radiological S&I for endoscopic retrograde cholangiopancreatography (ERCP), a procedure that is usually performed by a gastroenterologist. The Medicare Claims Processing Manual (Chapter 13, Section 80) states that the radiologist should apply modifier 52 to the S&I code when billing for interpretation of images that the radiologist did not supervise. The physician who performed the procedure should also apply modifier 52 to the S&I code because he or she supervised the imaging but did not interpret it.

The majority of the time there is no S&I code for the imaging guidance. For example, the radiologist may be asked to interpret spot images taken during a spinal fusion or knee replacement procedure. According to Clinical Examples in Radiology (Winter 2013), the radiologist “should report an X-ray code for the anatomic area imaged” – for example, the spine or the knee.

Sometimes a surgeon will submit several spot images that were taken in the same projection at different points during a surgical procedure. Because these images all represent the same view, it is not appropriate to assign a code for a multi-view exam. Also, because the images are all interpreted together at the conclusion of surgery, rather than being interpreted individually during the surgery with immediate feedback to the surgeon, they should be considered a single exam rather than separate exams. For example, simultaneous postop interpretation of three lateral cervical spine images taken during spine fusion surgery should be reported as one single-view exam (72020) rather than three single-view exams or one three-view exam (72040).

If it is appropriate to bill for these studies, you do not want to miss appropriate revenue. Conversely, it is important to ensure that you are not billing for studies inappropriately. Revisiting this concern on an annual basis is good practice from a revenue and compliance perspective.

Melody W. Mulaik, MSHS, CRA, RCC, RCC-IR, CPC, COC, FAHRA, is the president of Revenue Cycle and Coding Strategies Inc.

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